Oak Clinic Inc.
Oak Clinic, Sumiyoshi
Oak Clinic, Umeda
Oak Clinic, Ginza
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Pill Online®

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  1. Pill Online©TOP
  2. Application

Application for Pill Online®

Before examination, we must check the following items.
Please carefully read all items before contacting.

 

Questions about Patient

  • Oak ID (if you do not have an Oak ID, please call the clinic or for English service, email english_help@oakclinic-group.com)
  • Full Name
  • Date of Birth
  • Postal address
  • Phone Number
  • Email address
  • Height & Weight
  • Type of pill you want　
    ❏ Low-dose Pill
    ❏ Emergency Contraceptive Pill
    ❏ Menstrual Transfer Pill

Health Questions
(First Time)

  • Beginning and End Date of Last Menstrual Period:　
    　　　/　　/　　　～　　days
  • First menstruation date:　　　　years old,　Menopause date:　　　　years old
  • How long is your menstrual cycle:　　　　day cycle
  • Symptoms
    ❏ Heavy periods　❏ Light Periods　
    ❏ Strong pain　
    ❏ Use of pain medication（medication name: 　　　　　　）
  • ❏ Medicine　　❏ Food　　❏ Alcohol　　
    ❏ Latex　　❏ Anesthetic
    Detailed cause: 　　　　　　　, Allergy symptom: 　　　　　　　　　　　　　　　　　　

Interview Check

If any of the below apply, please provide the question number.

No. Topic
1

Are you under 18?
2

Are you over 35 and do you smoke more than 15 cigarettes per day?
3

Have you ever had hypersensitivity to other oral contraceptives or hormones?
4

Have you ever had a lump in your breast?
5

Do you ever have genital bleeding?
6

Have you experienced:
calf pain, swelling, shortness of breath, chest pain, severe headache, dizziness, blurred vision, or difficulty speaking?
7

Have you ever had a thrombotic vein, pulmonary thrombosis, cerebrovascular disease, or coronary artery disease?
8

Have you ever been told that you have a congenital thrombotic predisposition?
9

Have you ever been told that one of the following applies to you:
Phosopholipid antibody syndrome, Malignant tumor, Hemolytic anemia (sickle cell, thalassemia, etc.),
Concentrated coagulant infusion, Varicose veins, Hypertension,
Diabetes, Hyperlipidemia, Dehydration, Severe infection
10

Have you ever had a stillbirth or thrombocytopenia?
11

If you have been pregnant, were you told that you had high blood pressure?
12

If you have been pregnant, did you have jaundice, itching, or herpes?
13

Are you or could you possibly be pregnant?
14

Have you recently given birth (last 4 weeks) and are you currently breastfeeding?
15

Have you been told that you have heart disease or kidney problems?
16

Have you been told that you have diabetes or impaired glucose tolerance?
17

Have you been told that you have a liver problem?
18

Do you ever have migraines with aura?
19

Have you ever been told that you have otosclerosis?
20

Are you planning or have you recently had a major surgery?

Pills cannot be prescribed to those who say yes to any of the above (1-20)

No. Topic
21

Are you over 40?
22

Has anyone in your family ever been diagnosed with breast cancer?
23

Has any family member ever had thrombosis?
24

Have you been told that you have epilepsy? Have you had muscle spasms such as limb cramps?
25

Have you been told that you have porphyria?
26

Have you been told that you are obese?
27

Do you have migraines without aura?
28

Are you currently being treated for any medical condition?
29

Are you currently taking any medications?

If you say yes to any of the above (21-29) please consult with your doctor before calling Pill Online.

For Patients who want a low dose pill

If you cannot confirm the following contents, you cannot receive the pill.

If you take low-dose pills for a long time, it is recommended that you have the following tests performed once a year.
Since it is a general examination, it may be performed in a regular checkup or a company checkup, including at an internal medicine clinic.
If you want to be tested elsewhere, please check the results by yourself.
If there is an abnormality, please notify our hospital immediately.
This hospital prescribes the low-dose pill on the assumption that these tests are done once a year, and that there is no abnormality.
If you desire a test at our clinic, please make an appointment and visit in person.

    Test Once A Year
  • Liver function test (AST / ALT)
  • Blood coagulation test（PT / APTT）
  • Ultrasound of the uterus and ovaries
  • Cytology for cervical cancer

〔For reference, here are the fees at our hospital〕

  • Liver function test（AST / ALT）　¥2,130
  • Blood coagulation test（PT / APTT）　¥2,070
  • Both inspections together　¥3,850
  • Ultrasound of the uterus and ovaries　¥5,300
  • Cytologic examination for cervical cancer　¥3,400〔Osaka city residents aged 20 and over (every two years) ¥400〕

*All inspection costs are at your own expense.
*All prices do not include consumption tax.
*Please note that prices are subject to change without notice.

    (Notes)
  • Be sure to read the explanatory documents that are handed to you at the beginning, and make sure that you have them with you.
  • Please let us know if you have any illness or abnormalities in your body that may be the side effects of medication.
  • Unless otherwise requested, Pills are prescribed as if these examinations are received on a regular basis and that the results were normal.
  • Pills do not prevent testing for HIV or other sexually transmitted diseases. The use of condoms is effective in preventing these infections.

Online Medical Application Phone Number

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0120-009-345
 

*For English service please call 070-1820-0909.
English service is closed on Sunday and Monday.

 

Clinic Information